Pivotal Health (Pivotal), the IDR Authority™ and a full-service Independent Dispute Resolution (IDR) platform, announced a partnership with the Massachusetts Health & Hospital Association (MHA) to bring specialized, responsible IDR expertise and solutions to more than 75 hospital members in the Commonwealth.
The partnership comes as hospitals and health systems face growing financial pressure from rising costs and reimbursement that has not kept pace. Against that backdrop, IDR has become an important avenue for pursuing fair payment on certain out-of-network claims. Managing those processes successfully and responsibly, however, requires specialized knowledge, operational resources and a deep understanding of evolving requirements.
"The federal IDR process is a crucial tool for protecting patients from out-of-network billing issues, but it can be a complex and challenging process for healthcare providers to navigate ," said Dan McHale, MHA’s senior vice president of healthcare finance & policy. "Pivotal brings clarity grounded in real-world experience and a proven record of helping Massachusetts providers run compliant IDR efforts.”
Pivotal will serve as the preferred IDR partner for MHA's membership, working with hospitals and health systems to manage eligible disputes and recover fair reimbursement. The company will also provide educational resources to help members understand how IDR works in practice and stay current as policies and requirements evolve.
The partnership builds on Pivotal’s recent work with the Healthcare Association Coalition, which selected Pivotal as the exclusive IDR partner for its National Partnership Program. Through that collaboration, Pivotal provides IDR education, solutions and advocacy support to five hospital associations representing more than 350 hospitals nationwide.
“IDR has become a critical part of provider reimbursement operations, and hospitals and health systems increasingly recognize its role in protecting financial sustainability,” said Max Mangum, CEO and co-founder of Pivotal Health. “Having managed more than 2.5 million IDR claims, we’re proud to bring that experience to MHA so their members can get paid appropriately for the exceptional care they provide to patients.”
Pivotal’s technology-enabled platform supports providers throughout the end-to-end IDR process, from identifying eligible claims and preparing submissions to managing disputes and tracking performance. Today, Pivotal partners with more than 200 hospital-based providers nationwide, delivering an 89 percent win/success rate and a 5:1 return on investment.
